When was it ever well oiled and functioning?

I'm not suggesting it's a good thing. I'm saying there are a lot of US corporations poised to take advantage of medical advances.

The US funds more medical research than any other country. “In terms of absolute expenditures, China is the world's second biggest spender on R&D, with $468 billion versus the United States's investment of $582 billion in 2018 according to OECD's purchasing power parity comparison.”